Shelton suggests county consider third party transfers

The Logan County Commissioners met with Sterling Regional MedCenter CEO Jeff Shelton during a work session Tuesday, to discuss a possible third party providing ambulance transfers for the county.

Also joining the meeting was Sterling Fire Chief Kurt Vogel and City Manager Don Saling.

Shelton told the board he did not expect them to make any decisions at the meeting and he was not there to advocate on behalf of a third party company, he was just there to present information and have them as a team think about how to solve the problem that he's seeing regarding Advanced Life Support (ALS) transports.

From January 2015 through February 2016 there were 416 transfers from SRM's emergency room; of that Sterling Fire Department EMS team performed 167 transfers, about 42 percent, and air ambulance provided 165, 38 percent. "Those are both high volume transfers," he said. There are also ground EMS transfers done by other counties.

Shelton noted approximately 65 percent of the transfers done by SFD are 90 to 100 miles away. Taking into account time for loading and unloading the patient, prep and possible breakdowns, that's approximately five hours the ambulance is gone.

Right now, he said SFD's ALS transfer team is "being stretched thin to the point that we're not able to safely manage our patient care."

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Vogel noted they probably do one transfer a day by local ambulance. "That can be tough, when there's one out on transfer and they're calling us to do another transfer. There is times we can get two ambulances out on the road at the same time, but it's very rare that we can do that."

Shelton mentioned recently they had an incident where SFD's ALS person was off sick and they did not have a backup person, so there was no ALS team who could do transfers for a whole weekend. Vogel noted they did have an ALS team; they just didn't have a backup team.

While air ambulances can help in some of those situations, sometimes weather prevents them from flying. Shelton recalled a car accident in November or December, where the person couldn't be transported by air and no ground team was available, so the transport was delayed.

The third party company that he has looked into is very successful in Iowa, Nebraska and Kansas, and is in the process of expanding their service lines, possibly to Sidney, Neb., and also discussing if there's an option here, as well as to the Holyoke area.

"This has nothing to do with 911 services — that is the fire department; it needs to stay that way. But, by having this backup system in place, that does the actual transfers with EMS possibly being a backup team, though you would lose that revenue from transfers, you would have a solid transfer system in place that's not stretching these guys too thin," he told the board.

There would be no cost to the county, the city or SRM; it would be a third party contractor and they would not say no if someone had an inability to pay.

"It does bring jobs into our community, because they do not recruit the fire department staff; they actually recruit and bring in EMTs, paramedics to work in that setting," Shelton said.

He also talked about going another route, ensuring that Logan County's wages are competitive, so SFD can retain their employees, and increasing the quality of education for employees so they're prepared to move into an ALS role.

When asked about turnover rate, Vogel said the last year was really tough; they lost seven people, quite a few of whom were paramedics. Some of it was due to pay; some of it wasn't. Vogel noted Morgan County pays paramedics about $20,000 more than Logan County.

"We are working on a plan with our HR department, hoping to come up with some numbers," he said, adding that Fort Morgan is on a different system and their employees are working more hours than SFD employees due to overtime.

Rocky Samber asked if increasing wages would help the system not be stretched so much.

"No, because most people don't leave just because of pay; there's too many other things that play a part of that," Vogel told him. "I think because we're in rural America, like (Shelton) mentioned, we're going to continue to struggle. People are used to moving around a little bit more than what they used to do."

Dave Donaldson pointed out when the county went into the ambulance business the hospital had no interest in participating in an ambulance service at that time. He also asked how SRM's staffing of emergency room physicians has an impact on transports required.

Shelton said without solid physicians well trained in advanced care there can be a tremendous amount of transfers that shouldn't be occurring or you can be retaining people that shouldn't be retained. He told the board SRM has been with TeamHealth since September 2014 and they only allow staffing of ED certified physicians, not mi-level physicians.

"The way we staff is very much designed to address the high acuity level that we have and our acuity levels in our ER department has skyrocketed," he said, adding "we have trauma situations that are coming in regularly."

Donaldson suggested the hospital needs to look at whether physicians are requesting more transports than is necessary.

Vogel said they've met with the hospital to try to make improvements with ALS transfers. "We do get stretched out when doing transfers," he commented.

Samber asked whether the third party company would be backup. Shelton said they would do all transfers, unless they're already out on a run and there is no backup team there.

"Just from the service, it looks to me like potentially we could put our whole system in jeopardy revenue wise. That's concerning to me," Samber said. "We run the risk of maybe what has been a success story turned into a non-success story."

Shelton agreed right now it is a success story, "but it's fragile and has the potential to implode on itself; it's almost the brewing storm to become the perfect storm," he said. "I think we at least have to keep our eyes on this, because otherwise we're going to be blindsided and we're going to be in trouble."

"We want good patient care, but it's been our method of operation that we have to do what I just coin as mutual aid, that Akron has to come in and Morgan has to come, we have to go there. We kind of cover for each other when the demand is tight," Donaldson said.

Shelton noted the system isn't failing right now, "but you're on the cusp of failing, because the frequency of the events is increasing to the point it will become exacerbated and then we'll be rushing to solve a problem."

It was noted there is still a risk the third party wouldn't be available to do the transfer.

Donaldson asked if the company Shelton is looking at would have an interest in doing the whole ambulance service for Logan County.

Shelton said the purpose of a meeting that Banner is having with the company March 30 that the commissioners have been asked to attend is so the county can find out what the company is all about. At least one commissioner will attend the meeting.

"When I first heard about this, my concern was that they'll start off with transports and then they'll move in and move us out and I don't like that. I really believe we're the best thing for the community, especially for the 911 system," Vogel commented.

Donaldson said he doesn't want the community to think the ambulance service is substandard; "I think we're top quality." Shelton agreed that they have a good system. "I'm very pleased with what they're doing; they're just being stretched too thin," he said.

Samber asked if one of SRMs staff could be on SFDs transfer team. Shelton said that's not an option due to liability and workman's compensation issues.

"I have nothing to gain here by creating community worry or implying these guys aren't doing an effective job," Shelton said. "All I'm doing is sharing the information with you to say there's a potential of a concern."

Saling asked if there is an agreement between the county and Banner regarding transfers. Donaldson said there isn't, just between the county and the city.

"We have talked in the past about making sure that we get the number of transports that's an acceptable level and the fire department through Chief Vogel has made those efforts," Donaldson said.

He pointed out the commissioners want what's best for the community. "We want to have what we need, but we need that revenue as well, because we're supporting this ambulance service through the fire department, so it's all kind of interconnected."

"I agree whole-heartedly, it has a potential to be a success story beyond belief and potential to be a miserable failure," Shelton said. "All of us have the responsibility of assessing what the best options are."

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